Vakante Jobangebote finden Sie unter Projekte.
Medical Claims Review Nurse Job
Eingestellt von Yoh
Gesuchte Skills: Client
Projektbeschreibung
THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:
- Utilization Management experience
- Knowledge of CPT and ICD-9 coding
WHAT YOU'LL BE DOING:
- Provide timely medical review of claims and claims appeals related to CPT, HCPCS and/or ICD-9 coding, to ensure accuracy of modifiers, place of service and/or date of service and to make processing recommendations per established medical and/or coding criteria/conventions
- Perform retroactive review of claims requiring medical review, edits, and medical necessity submitted with and/or without prior authorization
- Verify and identify that claims and authorizations are reviewed for medical and coding appropriateness pre- and post-payment
- Review, refer and manage possible CCS cases
WHAT YOU NEED TO BRING TO THE TABLE:
- Current California RN or LVN license
- Three (3) years recent utilization management or quality management experience in a clinical setting
- Strong knowledge/understanding of CPT, HCPCS and ICD-9 coding required
- Strong knowledge/understanding of RBRVS-based and Medi-Cal fee schedules or payment systems required
- Understanding of the National Correct Coding Initiative and CPT coding rules/standards
- In-depth knowledge of AB-1455, regulations and procedures governing Medi-Cal and other state sponsored programs
- Direct experience in utilization management and/or quality management is required
BONUS POINTS! OTHERWISE KNOWN AS PREFERRED QUALIFICATIONS:
- Masters Degree in Nursing or a related field preferred
- Working familiarity with the basic principles of contract law, risk management and health care economics
WHAT ARE YOU WAITING FOR? APPLY NOW!
RECRUITER: Jennifer Andersen
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.
J2W: HC
MONJOBJ2WNWHLTH
Ref:
SFSF: REN
Projektdetails
-
Einsatzort:
Sacramento, Vereinigte Staaten
-
Projektbeginn:
asap
-
Projektdauer:
Keine Angabe
- Vertragsart:
-
Berufserfahrung:
Keine Angabe
Geforderte Qualifikationen
-
Kategorie:
IT Entwicklung